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Best Practice & Research. Clinical... Jan 2021Advanced maternal age is becoming an increasingly relevant issue in high-income developed countries. Lower fertility, greater need for assisted reproductive therapy, and... (Review)
Review
Advanced maternal age is becoming an increasingly relevant issue in high-income developed countries. Lower fertility, greater need for assisted reproductive therapy, and an increase in comorbidities, such as hypertension and diabetes, are some of the reasons for the rise in adverse maternal and fetal outcomes. This chapter reviews and summarizes the recent publications on the impact of advanced maternal age on pregnancy outcomes.
Topics: Female; Fertility; Humans; Maternal Age; Pregnancy; Pregnancy Outcome; Reproductive Techniques, Assisted
PubMed: 32773291
DOI: 10.1016/j.bpobgyn.2020.06.006 -
Acta Medica Portuguesa Mar 2019The risks of pregnancy in women of advanced maternal age are not consensual amongst studies. The aim of this metaanalysis was to determine whether women of advanced... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The risks of pregnancy in women of advanced maternal age are not consensual amongst studies. The aim of this metaanalysis was to determine whether women of advanced maternal age (≥ 35 years old) had worse obstetrical and perinatal outcomes than non- advanced maternal age women (20 - 34 years old) in singleton, naturally-conceived pregnancies.
MATERIAL AND METHODS
We searched PubMed/ MEDLINE, IndexRMP and the Cochrane Database of Systematic Reviews. Ten studies were included according to the following criteria: population of > 1000 nulliparous and/or multiparous women with singleton gestations who did not undergo any type of infertility treatment. Using Review Manager v. 5.3, two meta-analysis were performed: one comparing the outcomes of 20 - 34-year-old vs 35 - 40-year-old women, and another comparing the outcomes of 35 - 40-year-old women vs > 40-year-old women.
RESULTS
Women aged 35 - 40 years old were more likely to have > 12 years of education than 20 - 34 years old and > 40 years old women. Advanced maternal age women (35 - 40 and > 40 years old) were more likely to be overweight and having gestational diabetes and gestational hypertension. They were also more likely to undergo induced labour and elective caesarean deliveries. Furthermore, they had worse perinatal outcomes such as preterm delivery, low birthweight babies, higher rates of Neonatal Intensive Care Unit admission and worse Apgar scores. Advanced maternal age women had higher rates of perinatal mortality and stillbirth.
DISCUSSION
Most authors present similar results to our study. Although the majority of adverse outcomes can be explained through the physio-pathological changes regarding the female reproductive apparatus that come with aging and its inherent comorbidities, according to the existing literature advanced maternal age can be an independent risk factor per se. In older pregnant women without comorbidities such as gestational hypertension or diabetes there are still worse obstetric and perinatal outcomes, which indicate that advanced maternal age is an independent strong risk factor alone.
CONCLUSION
Advanced maternal age women are at a higher risk of adverse obstetrical and perinatal outcomes. In both comparisons, worse outcomes were more prevalent in the older group, suggesting that poorer outcomes are more prevalent with increasing age.
Topics: Adult; Cesarean Section; Diabetes, Gestational; Female; Humans; Labor, Induced; Maternal Age; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Stillbirth; Young Adult
PubMed: 30946794
DOI: 10.20344/amp.11057 -
Journal of Women's Health (2002) Feb 2021Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal...
Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ≥35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.
Topics: Adult; Female; Humans; Infant, Newborn; Male; Maternal Age; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, High-Risk; Premature Birth
PubMed: 33185505
DOI: 10.1089/jwh.2020.8860 -
National Vital Statistics Reports :... Jan 2023Objectives-This report presents 2021 data on U.S. births according to a variety of characteristics. Trends in fertility patterns and maternal and infant characteristics...
Objectives-This report presents 2021 data on U.S. births according to a variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.
Topics: Pregnancy; Female; Adolescent; Humans; United States; Maternal Age; Pregnancy in Adolescence; Birth Rate; Birth Certificates; Parturition
PubMed: 36723449
DOI: No ID Found -
Journal of Obstetrics and Gynaecology... Nov 2017To provide an overview of delayed child-bearing and to describe the implications for women and health care providers .
OBJECTIVE
To provide an overview of delayed child-bearing and to describe the implications for women and health care providers .
OPTIONS
Delayed child-bearing, which has increased greatly in recent decades, is associated with an increased risk of infertility, pregnancy complications, and adverse pregnancy outcome . This guideline provides information that will optimize the counselling and care of Canadian women with respect to their reproductive choices .
OUTCOMES
Maternal age is the most important determinant of fertility, and obstetric and perinatal risks increase with maternal age . Many women are unaware of the success rates or limitations of assisted reproductive technology and of the increased medical risks of delayed child-bearing, including multiple births, preterm delivery, stillbirth, and Caesarean section . This guideline provides a framework to address these issues .
EVIDENCE
Studies published between 2000 and August 2010 were retrieved through searches of PubMed and the Cochrane Library using appropriate key words (delayed child-bearing, deferred pregnancy, maternal age, assisted reproductive technology, infertility, and multiple births) and MeSH terms (maternal age, reproductive behaviour, fertility) . The Internet was also searched using similar key words, and national and international medical specialty societies were searched for clinical practice guidelines and position statements . Data were extracted based on the aims, sample, authors, year, and results .
VALUES
The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.
SPONSOR
The Society of Obstetricians and Gynaecologists of Canada.
Topics: Adult; Canada; Female; Humans; Maternal Age; Maternal Health Services; Pregnancy; Pregnancy Outcome; Prenatal Care; Risk Factors
PubMed: 29080737
DOI: 10.1016/j.jogc.2017.09.007 -
Redox Biology Jan 2021
Topics: Aneuploidy; Female; Follicular Fluid; Humans; Maternal Age; Melatonin; Oocytes
PubMed: 33341428
DOI: 10.1016/j.redox.2020.101831 -
Human Reproduction (Oxford, England) Jun 2021Do daughters of older mothers have lower fecundability?
STUDY QUESTION
Do daughters of older mothers have lower fecundability?
SUMMARY ANSWER
In this cohort study of North American pregnancy planners, there was virtually no association between maternal age ≥35 years and daughters' fecundability.
WHAT IS KNOWN ALREADY
Despite suggestive evidence that daughters of older mothers may have lower fertility, only three retrospective studies have examined the association between maternal age and daughter's fecundability.
STUDY DESIGN, SIZE, DURATION
Prospective cohort study of 6689 pregnancy planners enrolled between March 2016 and January 2020.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Pregnancy Study Online (PRESTO) is an ongoing pre-conception cohort study of pregnancy planners (age, 21-45 years) from the USA and Canada. We estimated fecundability ratios (FR) for maternal age at the participant's birth using multivariable proportional probabilities regression models.
MAIN RESULTS AND THE ROLE OF CHANCE
Daughters of mothers ≥30 years were less likely to have previous pregnancies (or pregnancy attempts) or risk factors for infertility, although they were more likely to report that their mother had experienced problems conceiving. The proportion of participants with prior unplanned pregnancies, a birth before age 21, ≥3 cycles of attempt at study entry or no follow-up was greater among daughters of mothers <25 years. Compared with maternal age 25-29 years, FRs (95% CI) for maternal age <20, 20-24, 30-34, and ≥35 were 0.72 (0.61, 0.84), 0.92 (0.85, 1.00), 1.08 (1.00, 1.17), and 1.00 (0.89, 1.12), respectively.
LIMITATIONS, REASONS FOR CAUTION
Although the examined covariates did not meaningfully affect the associations, we had limited information on the participants' mother. Differences by maternal age in reproductive history, infertility risk factors and loss to follow-up suggest that selection bias may partly explain our results.
WIDER IMPLICATIONS OF THE FINDINGS
Our finding that maternal age 35 years or older was not associated with daughter's fecundability is reassuring, considering the trend towards delayed childbirth. However, having been born to a young mother may be a marker of low fecundability among pregnancy planners.
STUDY FUNDING/COMPETING INTEREST(S)
PRESTO was funded by NICHD Grants (R21-HD072326 and R01-HD086742) and has received in-kind donations from Swiss Precision Diagnostics, FertilityFriend.com, Kindara.com, and Sandstone Diagnostics. Dr Wise is a fibroid consultant for AbbVie, Inc.
TRIAL REGISTRATION NUMBER
n/a.
Topics: Adult; Canada; Cohort Studies; Female; Fertility; Humans; Infant, Newborn; Maternal Age; Middle Aged; Nuclear Family; Pregnancy; Prospective Studies; Retrospective Studies; Time-to-Pregnancy; Young Adult
PubMed: 33860312
DOI: 10.1093/humrep/deab057 -
American Journal of Obstetrics and... Oct 2019
Topics: Blastocyst; Embryo Implantation; Maternal Age; Humans; Female; Pregnancy
PubMed: 31288007
DOI: 10.1016/j.ajog.2019.07.012 -
Best Practice & Research. Clinical... Jan 2021Pregnancies at an advanced reproductive age are increasingly common. However, the safety of pregnancy remains a concern as maternal age is a recognized independent... (Review)
Review
Pregnancies at an advanced reproductive age are increasingly common. However, the safety of pregnancy remains a concern as maternal age is a recognized independent factor for various obstetric complications. Also, age is a risk factor for most systematic health problems and older women are more likely to enter into pregnancy with pre-existing conditions. At the moment there is no separate, structured guidance on preconception tests at advanced maternal age. However, the preconceptual period offers an ideal window to recognize and address underlying health issues, social issues and harmful lifestyle behaviours in order to optimize maternal health ultimately reducing infertility, perinatal morbidity and mortality. Preconception tests should be clinically relevant aiming to identify risk factors and address them to predict and prevent infertility and pregnancy complications. The importance of preconception care is magnified for women of advanced age for whom the risks are higher and the potential benefits greater.
Topics: Aged; Female; Humans; Maternal Age; Preconception Care; Pregnancy; Pregnancy Complications; Risk Factors
PubMed: 33358154
DOI: 10.1016/j.bpobgyn.2020.11.003 -
Reproduction, Fertility, and Development Dec 2021Although puberty can occur as early as 14-15months of age, depending on breed and use, the reproductive career of mares may continue to advanced ages. Once mares are... (Review)
Review
Although puberty can occur as early as 14-15months of age, depending on breed and use, the reproductive career of mares may continue to advanced ages. Once mares are used as broodmares, they will usually produce foals once a year until they become unfertile, and their productivity can be enhanced and/or prolonged through embryo technologies. There is a general consensus that old mares are less fertile, but maternal age and parity are confounding factors because nulliparous mares are usually younger and older mares are multiparous in most studies. This review shows that age critically affects cyclicity, folliculogenesis, oocyte and embryo quality as well as presence of oviductal masses and uterine tract function. Maternal parity has a non-linear effect. Primiparity has a major influence on placental and foal development, with smaller foals at the first gestation that remain smaller postnatally. After the first gestation, endometrial quality and uterine clearance capacities decline progressively with increasing parity and age, whilst placental and foal birthweight and milk production increase. These combined effects should be carefully balanced when breeding mares, in particular when choosing and caring for recipients and their foals.
Topics: Animals; Birth Weight; Female; Horses; Maternal Age; Parity; Placenta; Pregnancy; Pregnancy, Animal
PubMed: 35231230
DOI: 10.1071/RD21267